| The Healing Impact, Inc | |
|
4 9th Ave Ste F Shalimar FL 32579-1742 | |
| (505) 412-5292 | |
| Not Available |
| Full Name | The Healing Impact, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 4 9th Ave Ste F, Shalimar, Florida |
| Authorized Official Name and Position | Kaitlyn Churchman Abadia (CO-PRESIDENT) |
| Authorized Official Contact | 8502183062 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Healing Impact, Inc Po Box 406 Shalimar FL 32579-0406 Ph: () - | The Healing Impact, Inc 4 9th Ave Ste F Shalimar FL 32579-1742 Ph: (505) 412-5292 |
| NPI Number | 1154988772 |
|---|---|
| Provider Enumeration Date | 05/20/2019 |
| Last Update Date | 09/30/2021 |
| Certification Date | 09/30/2021 |
| Medicare PECOS PAC ID | 2062748064 |
|---|---|
| Medicare Enrollment ID | O20190730000520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154988772 | NPI | - | NPPES |
| 1043853435 | Other | FL | NPI |
| 1861792467 | Other | NPI | |
| 1013499664 | Other | EMPLOYEE NPI | |
| 1345573506 | Other | FL | NPI |
| 1720560675 | Other | FL | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kaitlyn C Abadia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013499664 PECOS PAC ID: 3476882812 Enrollment ID: I20190910001416 |
| Provider Name | Heidi Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720560675 PECOS PAC ID: 4880014687 Enrollment ID: I20201016000851 |
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